Healthcare Provider Details

I. General information

NPI: 1023116233
Provider Name (Legal Business Name): UNIVERSITY THORACIC SURGEONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST SUITE 774
CHICAGO IL
60612
US

IV. Provider business mailing address

1725 W HARRISON ST SUITE 774
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6725
  • Fax: 312-942-6730
Mailing address:
  • Phone: 312-942-6725
  • Fax: 312-942-6730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JANICE BURKART
Title or Position: AUTHORIZED OFFICIAL/ADMINISTRATOR
Credential:
Phone: 312-563-4334